A Systematic Review and Meta-Analysis of Negative Wound Pressure Therapy Use in Soft Tissue Sarcoma Resection

Background: Negative wound pressure therapy (NWPT) may reduce the wound complication (WC) risk in soft tissue sarcoma (STS) and is often utilized for large and/or irradiated wounds, extensive dissections, or wounds at risk of impaired drainage. However, data on WCs after NWPT in STS are lacking. This study systematically reviewed the available literature on NWPT in STS.

Methods: A query of the Cochrane Central Register of Controlled Trials (1976-2022), Cochrane Database of Systematic Reviews, MEDLINE (1946-2022), Scopus, and PubMed (1964-2022) was performed. Eight studies met inclusion.

Results: One-hundred eighty-six cases were analyzed. Among studies with available data, myxofibrosarcoma (n=32/131; 24.4%) and undifferentiated pleomorphic sarcoma (n=29/131; 22.1%) were the most common subtypes, 83.3% (n=90/108) were lower extremity STS, and 51.9% (n=82/158) were preoperatively irradiated. The overall WC rate was 10.8% (n=20/186). Pooled-analysis (three studies) demonstrated a lower WC risk with NWPT versus conventional dressings (OR, 0.133; 95% CI, 0.050-0.351; p<0.001; I²=0%). Subsequent analysis (two studies) found no increased local recurrence risk versus conventional dressings (OR, 1.019; 95% CI, 0.125-8.321; p=0.99), with high heterogeneity.

Conclusion: NWPT appears to lower the WC risk in STS without increasing the recurrence risk, and may be suitable for primary, recurrent, or positive margin resections, staged reconstructions, and while awaiting histologic margin assessment. However, larger, randomized-controlled trials of NWPT in STS are warranted. Level of Evidence: III.